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Organization
SUNCOAST THERAPY, LLC
Active
Organization
SUNCOAST THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAWN WILDERMUTH SLP (OWNER)
(941) 485-0121
Entity
Organization
Contact information
Practice address
464073 STATE ROAD 200, YULEE, FL 32097-6307
(941) 485-0121
(941) 485-0519
Mailing address
PO BOX 631278, CINCINNATI, OH 45263-1278
(941) 485-0121
(941) 485-0519
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103K00000X
Behavior Analyst
—
—
1041C0700X
Clinical Social Worker
—
—
106H00000X
Marriage & Family Therapist
—
—
224Z00000X
Occupational Therapy Assistant
—
—
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Enumeration date
05/31/2021
Last updated
05/31/2021
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